Publications by authors named "Ana Lúcia Lei Munhoz Lima"

18 Publications

  • Page 1 of 1

Performance of alpha-defensin lateral flow test after synovial fluid centrifugation for diagnosis of periprosthetic knee infection.

World J Orthop 2021 Aug 18;12(8):565-574. Epub 2021 Aug 18.

Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo 05403-010, Brazil.

Background: The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.

Aim: To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis.

Methods: Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria. Synovial fluid samples were submitted to centrifugation, and the supernatant was evaluated by ELISA and lateral flow tests. The sensitivity (SE), specificity (SP) and accuracy of each method were calculated as well as the agreement between those two methods.

Results: In all of the 31 samples from aseptic patients, alpha-defensin ELISA and lateral flow tests showed negative results for infection. Regarding the 22 infected patients, the lateral flow test was positive in 19 cases (86.4%) and the ELISA was positive in 21 (95.5%). Sensibility, SP and accuracy were, respectively, 86.4% (95%CI: 65.1%-97.1%), 100% (95%CI: 88.8%-100%) and 93.2% (95%CI: 82.8%-98.3%) for the lateral flow test and 95.5% (95%CI: 77.2%-99.9%), 100% (95%CI: 88.8%-100%) and 98.1% (95%CI: 89.9%-100%) for ELISA. An agreement of 96.2% between those methods were observed. No statistical difference was found between them ( = 0.48).

Conclusion: Alpha-defensin lateral flow test showed high SE, SP and accuracy after a prior synovial fluid centrifugation, achieving comparable results to ELISA. Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition, a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.
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http://dx.doi.org/10.5312/wjo.v12.i8.565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384616PMC
August 2021

Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up.

Injury 2021 Jul 1;52 Suppl 3:S23-S28. Epub 2021 Jun 1.

Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.

Introduction: Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass.

Methods: We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores).

Results: Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases.

Conclusion: The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass.
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http://dx.doi.org/10.1016/j.injury.2021.05.030DOI Listing
July 2021

Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention.

BMC Musculoskelet Disord 2020 Aug 24;21(1):574. Epub 2020 Aug 24.

Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 333 Dr Ovídeo Pires de Campos St, São Paulo, Zip Code 05403-010, Brazil.

Background: Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention.

Methods: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics.

Results: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05).

Conclusion: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.
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http://dx.doi.org/10.1186/s12891-020-03570-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445907PMC
August 2020

Prosthetic joint infection due to Candida species: Case series and review of literature.

Medicine (Baltimore) 2020 Apr;99(15):e19735

Instituto de Ortopedia e Traumatologia, Hospital das Clíncias HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.

Introduction: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014.

Patient Concerns: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases.

Diagnosis: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series.

Interventions: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases.

Outcomes: After the initial management, 73% of the patients achieved clinical remission.

Conclusion: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases.

Descriptors: Prosthetic joint infection, Candida, treatment, and diagnosis.
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http://dx.doi.org/10.1097/MD.0000000000019735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220503PMC
April 2020

A RETROSPECTIVE CASE-SERIES ON THE USE OF S53P4 BIOACTIVE GLASS FOR THE ADJUNCTIVE TREATMENT OF SEPTIC DIAPHYSEAL NON-UNION.

Acta Ortop Bras 2019 Sep-Oct;27(5):273-275

Universidade de São Paulo, Hospital das Clínicas - HCFMUSP, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Reconstruction and Lengthening Group, São Paulo, SP, Brazil.

Objective: Non-union and persistence of infection at a fracture site for long periods are always described as a challenge to orthopedists, especially in cases of severe compound fractures with comminution and segmental bone loss. This is a case series of septic non-unions, using S53P4 bioactive glass for adjunctive treatment, using internal syntheses or external fixators. The objective is to retrospectively evaluate the results of the use of S53P4 bioglass for the adjunctive treatment of septic non-unions.

Methods: We reviewed 18 patients with septic non-unions. The patients were preoperatively classified using the Non-union Scoring System (NUSS) and union outcomes were assessed by the modified radiographic union scale in tibial (RUST) fractures. Of the 18 patients treated, six underwent internal osteosynthesis and 12 were treated with external fixators in combination with bioactive glass grafting.

Results: The patients had a mean NUSS score of 56.6 (standard deviation of 7.6) and fracture union was achieved according to the RUST score in 17 of 18 cases (94.4%), with a mean value of 10.2 (standard deviation of 1.0). One patient was lost to follow-up. Reevaluation using the modified RUST score was 12.3 (SD = 1.0), maintaining union of 17/18.

Conclusion: The fracture union rate was high, according to the literature, as was control of infection.
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http://dx.doi.org/10.1590/1413-785220192705220540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901156PMC
December 2019

INCISIONAL NEGATIVE-PRESSURE WOUND THERAPY IN REVISION TOTAL HIP ARTHROPLASTY DUE TO INFECTION.

Acta Ortop Bras 2018 ;26(5):300-304

Universidade de São Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Knee Group, São Paulo, SP, Brazil.

Objective: To present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula.

Methods: We prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infectious process and healing of the surgical wound without complications were considered an initial favorable outcome.

Results: We assessed 10 patients who used PICO in our department. No complications were identified in association with the use of the NPWT device. The mean follow-up of the patients after use of the device was 12.7 months. Only one patient progressed with fistula reactivation and recurrence of infection.

Conclusion: NPWT can be used in wound complications and infection following THA procedures safely and with promising results. Randomized prospective studies should be conducted to confirm its effectiveness.
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http://dx.doi.org/10.1590/1413-785220182605196038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220663PMC
January 2018

Social profile and cost analysis of deep infection following total hip replacement surgery.

Rev Bras Ortop 2017 Nov-Dec;52(6):720-724. Epub 2017 Oct 23.

Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection.

Methods: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group.

Results: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40.

Conclusion: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.
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http://dx.doi.org/10.1016/j.rboe.2017.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720842PMC
October 2017

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures.

Rev Bras Ortop 2016 Jul-Aug;51(4):396-9. Epub 2016 Feb 2.

Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

Objective: To evaluate the incidence and microbiological profile of surgical site infections (SSIs) associated with internal fixation of fractures and to compare differences in the SSIs observed among patients with closed and open fractures.

Methods: Retrospective study. Analyzed data included information from all patients who underwent surgery for fixation of closed or open fractures from January 2005 to December 2012 and remained outpatients for at least one year following surgery. Incidence of surgical site infection (SSI) was compared between patients with closed and open infection, as well as polymicrobial infection and infection related to Gram-negative bacilli (GNB). Cumulative antibiograms were performed to describe microbiological profiles.

Results: Overall incidence of SSI was 6%. This incidence was significantly higher among patients with open fractures (14.7%) than among patients with closed fractures (4.2%). The proportions of patients with polymicrobial infections and infections due to GNB were also significantly higher among patients with open fractures. Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species were the primary infectious agents isolated from both groups. The overall incidence of MRSA (methicillin-resistant S. aureus) was 72%. A. baumannii was the predominant GNB isolate recovered from patients with open fractures and P. aeruginosa was the most frequent isolate recovered from patients with closed fractures, both exhibited low rates of susceptibility to carbapenems.

Conclusions: Incidence of SSIs related to the internal fixation of fractures was significantly higher among patients with open fractures, indicating that an open fracture can be a risk factor for infection. Among the bacterial isolates, S. aureus (with a high prevalence of MRSA) and CoNS species were most prevalent. A. baumannii and P. aeruginosa isolates underscored the low rate of susceptibility to carbapenems that was observed in the present study.
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http://dx.doi.org/10.1016/j.rboe.2015.09.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974164PMC
August 2016

Advances in treating exposed fractures.

Rev Bras Ortop 2015 Mar-Apr;50(2):125-30. Epub 2015 Feb 26.

Department of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.

The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.
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http://dx.doi.org/10.1016/j.rboe.2015.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519576PMC
August 2015

Kager's fat pad inflammation associated with HIV infection and AIDS: MRI findings.

Skeletal Radiol 2014 Sep 12;43(9):1257-62. Epub 2014 Jun 12.

Department of Orthopedic Surgery, University of São Paulo, Rua Ovídio Pires de Campos 333 Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil,

Objective: To describe magnetic resonance imaging (MRI) features of Kager's fat pad inflammation in HIV-positive patients with lipodystrophy due to protease inhibitor treatment and posterior ankle pain.

Methods: A case-control, cross-sectional study; group 1 included 14 HIV-positive patients using protease inhibitors, presenting lipodystrophy syndrome and having posterior ankle pain; group 2 (CGHIV-) included 112 HIV-negative patients without lipodystrophy syndrome who were being evaluated for posterior ankle pain; group 3 (CGHIV + 1) included 23 HIV-positive patients not using a protease inhibitor, without lipodystrophy syndrome and with posterior ankle pain; group 4 (CGHIV + 2) comprised 18 HIV-positive patients who were being treated with a protease inhibitor and had lipodystrophy syndrome but did not have posterior ankle pain. Images were evaluated for the presence of edema by two radiologists who were blinded to clinical features. Fisher's exact test was used to evaluate differences among the groups. Interobserver variation was tested using Cohen's kappa (κ) statistic.

Results: The presence of edema within Kager's fat pad was strongly associated with symptoms in HIV-positive patients who had lipodystrophy (p ≤ 0.0001). Concordance between observers was excellent (κ > 0.9).

Conclusion: MRI findings of Kager's fat pad inflammation related to HIV/AIDS is a source of symptoms in HIV patients with posterior ankle pain using protease inhibitors and having lipodystrophy syndrome.
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http://dx.doi.org/10.1007/s00256-014-1931-5DOI Listing
September 2014

Gram-negative osteomyelitis: clinical and microbiological profile.

Braz J Infect Dis 2012 Jan-Feb;16(1):63-7

Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, SP, Brazil.

Introduction: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature.

Objectives And Methods: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo.

Results: Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii.

Conclusion: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.
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September 2012

Osteopenia and osteoporosis in people living with HIV: multiprofessional approach.

HIV AIDS (Auckl) 2011 8;3:117-24. Epub 2011 Dec 8.

Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.

Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.
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http://dx.doi.org/10.2147/HIV.S6617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257973PMC
October 2012

Carbapenem stewardship: positive impact on hospital ecology.

Braz J Infect Dis 2011 Jan-Feb;15(1):1-5

Institute of Orthopedics and Traumatology Infection Control Service, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, SP, Brazil.

Introduction: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility.

Objective: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use.

Methods: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined.

Results: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved.

Conclusion: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.
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http://dx.doi.org/10.1016/s1413-8670(11)70131-3DOI Listing
September 2011

UPDATE ON INFECTIONS IN ARTICULAR PROSTHESIS.

Rev Bras Ortop 2010 Nov-Dec;45(6):520-3. Epub 2015 Nov 16.

Infectologist in the Infections Clinic, IOT-HC/FMUSP.

The implantation of joint prostheses, especially for the hip and knee, is becoming increasingly common. This provides a significant reduction in discomfort and an immeasurable improvement in patient mobility. Reviews of the worldwide literature indicate that 1 to 5% of these prostheses become infected, although it is important to remember that as the number of operations performed to implant these prosthesis increases, so will the number of cases of this type of infection. Gram-positive bacteria predominate in contaminations of joint prostheses, in particular Staphylococcus aureus and Staphylococcus epidermidis. Infections caused by gram-negative bacilli and fungi such as Candida sp have been reported with increased frequency throughout the world. Infections of joint prostheses present characteristic signs that can be divided into acute manifestations (severe pain, high fever, toxemia, heat, redness and wound secretions) and chronic manifestations (progressive pain, cutaneous fistula formation and pus drainage, without fever). The definitive diagnosis of the infection should be made through cultures to isolate the microorganism, using material collected from joint fluid puncture, surgical wound secretions, and surgical debridement. It is essential to cover for methicillin-resistant Staphylococcus aureus, given the epidemiological importance of this agent in these infections. The total duration of antibiotic therapy ranges from six weeks to six months, and this treatment should be adjusted as needed, based on the results from culturing.
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http://dx.doi.org/10.1016/S2255-4971(15)30296-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799166PMC
March 2016

ORTHOPEDIC COMPLICATIONS IN HIV PATIENTS.

Rev Bras Ortop 2009 Jan 16;44(3):186-90. Epub 2015 Nov 16.

Institute of Orthopedics and Traumatology (IOT), Hospital das Clínicas, School of Medicine, Universidade de Sao Paulo.

The considerable increase of the life expectancy of HIV-infected patients in the age of highly-powerful antiretroviral treatment results in important metabolic and bone-joint changes resulting from a long-lasting viral infection time and from this treatment. The most common orthopaedic complications are bone mineralization changes, osteonecrosis, carpal tunnel syndrome and gleno-humeral adhesive capsulitis, with different clinical presentation features, natural disease progression and therapeutic response compared to the overall population. Literature reports are initial, and the experience of the multidisciplinary service of the University of Sao Paulo's Institute of Orthopaedics and Traumatology enables us a more indepth knowledge about the various pathologies involved and the development of treatment protocols that are appropriate to these diagnoses.
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http://dx.doi.org/10.1016/S2255-4971(15)30066-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783691PMC
January 2009

Influence of ertapenem administration on the incidence of carbapenem-resistant Pseudomonas aeruginosa.

Braz J Infect Dis 2008 Apr;12(2):105-6

Institute of Orthopedics and Traumatology, Clinical Hospital, Medical School, São Paulo University, São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/s1413-86702008000200001DOI Listing
April 2008

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy.

Braz J Infect Dis 2007 Aug;11(4):426-9

Institute of Orthopedics and Traumatology, Clinics Hospital, School of Medicine, University of São Paulo, Brazil.

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.
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http://dx.doi.org/10.1590/s1413-86702007000400012DOI Listing
August 2007

Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer.

Clinics (Sao Paulo) 2007 Apr;62(2):99-108

Department of Orthopedics, Medical School, São Paulo University, São Paulo, SP, Brazil.

Purpose: Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties--with or without an antibiotic-loaded cement spacer.

Methods: In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages without the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 4 years (2-8.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study.

Results: The 2-stage surgery without spacer controlled the infection in 66.7% of patients, and the 2-stage surgery using the spacer controlled it in 89.1% (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5% of patients with good results against 60.0% for the control group).

Conclusion: The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer.

Level Of Evidence: Therapeutic study, Level I-1.
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http://dx.doi.org/10.1590/s1807-59322007000200002DOI Listing
April 2007
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